Canada and the United States are the only two OECD countries that do not provide public coverage to enable access to prescription drugs for the entire population. The fragmentation of drug insurance plans between private and provincial public plans has led to an incoherent system where waste and the interplay of corporate interests are prevalent.
After the United States, Canadians pay the highest costs per capita for prescription drugs ($771), which is 55% more than the average for OECD countries ($498). There are two reasons for that difference with the other OECD countries: 1 we pay more for the same drugs (since the fragmentation of plans reduces bargaining power); 2 the private plans lead to a logic of waste where all products are reimbursed, regardless of their therapeutic value.
But that doesn’t mean that we have better access to drugs. One Canadian out of 10 does not get his/her prescriptions filled for financial reasons.
In fact, the current drug coverage system is not sustainable in the long term. The Canadian system is not prepared for the arrival of a new generation of very expensive niche drugs, and we are still not protected against predatory price strategies in the pharmaceutical sector: for example, a hedge fund repurchasing a molecule to increase its price 5,500% in order to make a quick pile of money.
Major reforms are going to be needed either by transferring the risk onto the shoulders of patients by reducing the coverage or increasing deductibles and co insurance, or by transforming the coverage plan to make it effective by drawing on best practices in OECD countries.
I have graded each party’s position on drug issues
Green Party: (B+)
First to speak on the issue of prescription drugs, the party endorsed the report “The Future of Drug Coverage in Canada” (which I co authored and is endorsed by more than 100 health policy specialists). The report proposes drawing on best practices by establishing a universal public plan to enable better access, reduced costs, greater funding equity, elimination of waste and improved prescription habits. However the Greens Party does not lay out a process for implementing such a reform.
New Democratic Party: (A)
The party embraced the recommendations from “The Future of Drug Coverage” report, but also advanced a detailed description for implementing such a policy over four years. Modest amounts would first be spent to build up the administrative capacity for such a policy and enable defragmentation by developing a common list of drugs, helping increase bargaining power and reducing costs. The savings achieved would then be used to develop universal public coverage.
Bloc Québécois: (C-)
The Bloc proposed amending the rules of the Patented Medicine Prices Review Board to help reduce the official price of patented medicines by roughly 10%. However, that policy, which I myself proposed in 2010, is now somewhat inadequate because the official price of patented medicines has become barely relevant in a world where the public plans negotiate confidential rebates.
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Conservative Party: (F)
The Conservatives stated their intention to join the Pan-Canadian Pharmaceutical Alliance (PCPA), a bulk-purchasing agency developed by the provinces to increase their bargaining power. Even though price-setting for patented medicines is federal jurisdiction, the Conservatives have done nothing to reduce the costs. Quite the opposite: ratification of the Comprehensive Economic and Trade Agreement with Europe is going to increase the cost of patented medicines by at least 6% by extending intellectual property. Also, ratification of the TransPacific Partnership includes a Healthcare Annex that would govern the operation of the PCPA and undermine its bargaining power.
Liberal Party: (F)
The Liberals established an interesting National Pharmaceuticals Strategy in 2004 and their 2014 national convention called for a Liberal Government to take leadership in establishing a national Pharmacare program. During the election campaign, however, the Liberals simply repeated the Conservatives’ idea of joining the PCPA, while endorsing the trade agreements that are likely to undermine the meager Canadian institutional efforts to keep drug costs under control. Liberals also mentioned they would fund research on overprescribing but without any details. It is unclear if this funding would be larger than what it currently is for initiatives like the Drug Safety and Effectiveness Network.
Party positions notwithstanding, the current campaign deserves credit for raising these issues, raising awareness of the importance of the pharmaceutical challenges we face, and building a consensus that we are paying too much for our drugs and that reforms are needed. It is now a question of what reforms will be implemented.